In the evolving landscape of biologic therapies for severe asthma, two heavy hitters stand out: dupilumab (targeting IL-4/IL-13 downstream in the type 2 inflammatory pathway) and tezepelumab (blocking TSLP upstream, with potential broader effects across T2-high and T2-low phenotypes). While both are FDA-approved for severe asthma, direct comparative real-world evidence has been scarce -until now.
The study authors conclude that, in this real-world cohort, dupilumab and tezepelumab appear comparably effective at preventing exacerbations and reducing steroid reliance - no evidence that tezepelumab's upstream mechanism translated to superior outcomes overall.
For clinicians managing severe asthma, this suggests that - pending more data - either biologic is a reasonable option, guided by patient-specific factors like T2 biomarker profile, comorbidities, insurance/cost, administration preferences, and side-effect considerations rather than expecting a dramatic efficacy edge from one over the other.
As biologic options expand, studies like this help ground decisions in real-world practice rather than trial extrapolations alone.
References:
https://www.jaci-inpractice.org/article/S2213-2198(25)01129-8/fulltext